Breast lump: Early evaluation is essential
Breast lump: Early evaluation is essential
If you find a breast lump or other change in your breast, you might be worried about breast cancer.
That's understandable — but remember that breast lumps are common and not necessarily cancerous. In fact, for women in their 20s to early 50s, an estimated 90 percent or more of suspicious breast lumps are noncancerous (benign). Still, it's important to have any breast lump evaluated by a doctor.
How breast tissue normally feels
Breasts contain tissues of varying consistency. The glandular tissue in the upper, outer part of the breast usually feels firm and slightly rope-like, bumpy or lumpy (nodular). The surrounding fat tissue, often felt in the inner and lower parts of the breast, is soft.
You might find that breast-related symptoms, such as tenderness or lumpiness, change over the course of your menstrual cycle.
Breast tissue also changes as you age, typically becoming more fatty and less dense over time.
When to consult your doctor
Being familiar with your normal breast consistency can help you determine if there's a change in your breasts.
Consult your doctor if:
Skin crusting or nipple inversion — when a nipple that wasn't inverted turns inward — might be a sign of a problem with your breast. If you notice these or other breast changes, consult ...
What to expect during a clinical breast exam
Evaluation of a breast lump typically begins with a clinical breast exam. During this exam, your doctor will likely:
If your doctor confirms that you have a breast lump or other area of concern, you'll likely need testing to determine what's causing the problem.
Procedures to evaluate a breast lump
To further evaluate a breast lump, your doctor might recommend one or more of the following procedures. The size, location and other characteristics of the lump — as well as your personal preferences — can all influence which procedure your doctor recommends.
Depending on the circumstances, your doctor might be able to do the procedure in his or her office. In other cases, you might be referred to a radiologist or surgeon.
Unlike a screening mammogram, which is done when there are no particular breast concerns, a diagnostic mammogram provides views from several angles at higher magnification — focusing on the suspicious area. This can help your doctor precisely locate and determine the size of the lump or abnormality.
A diagnostic mammogram is often done in combination with an ultrasound of the breast to further evaluate the abnormality. During an ultrasound, sound waves are used to create images of your breast on a monitor.
If your doctor suspects cancer, he or she will likely use a needle to collect a small amount of breast tissue (biopsy) for lab analysis.
If the breast lump isn't painful and the ultrasound appears normal, further testing or treatment might not be needed.
If the breast lump hurts, your doctor might use ultrasound to guide fine-needle aspiration — a procedure in which any fluid is removed from the lump with a special needle. This can help relieve pain.
If ultrasound reveals that the lump is solid, your doctor will likely use a needle to collect a small amount of breast tissue (biopsy) for lab analysis.
Magnetic resonance imaging
When MRI is used to detect breast cancer, a special dye (contrast agent) must be injected into your veins before the procedure. The dye enhances the appearance of certain tissues in the MRI images, allowing a radiologist to tell which areas are most likely to be cancerous or noncancerous.
MRI scans can be challenging to interpret. This can lead to a false-positive result — when the test result is positive but cancer isn't actually present — or the need for additional testing.
If the lump contains clear fluid, it's most likely a cyst — a sac that can be filled with air, fluid or other material. Most cysts are noncancerous (benign) and will disappear as the fluid is removed.
If the lump contains bloody or cloudy fluid or it's solid, a sample of fluid or tissue will be sent to a lab for analysis. This might be followed by additional tests of tissues samples to determine whether the lump is cancerous.
Options for breast biopsy might include:
After any type of biopsy, the tissue sample is sent to a lab for analysis. Your doctor will let you know when to expect the test results.
During fine-needle aspiration, a special needle is inserted into a breast lump and any fluid is removed (aspirated). Ultrasound — a procedure that uses sound waves to create images of your ...
Core needle biopsy
During a core needle biopsy, a special needle is inserted into the suspicious area — in this case, a breast lump — and a small, solid core of tissue is withdrawn. Ultrasound — a ...
During a breast MRI, you lie on your stomach on a padded scanning table. Your breasts fit into a hollow depression in the table, which contains coils that detect magnetic signals. The table slides ...
Stereotactic breast biopsy
During a stereotactic breast biopsy, your breast will be firmly compressed between two plates. X-rays (mammograms) are used to produce stereo images — images of the same area from different ...
Follow-up after breast lump evaluation
If the breast lump doesn't seem to be cancerous, your doctor might suggest short-term monitoring followed by another exam in a few months to assess the area for stability. Consult your doctor if you notice any changes in the lump or develop any new areas of concern.
If the diagnosis is in question — the clinical breast exam and the mammogram show areas of suspicion, for example, but the pathology report from the biopsy reveals benign tissue — you'll be referred to a surgeon or other specialist for further consultation.
If the breast lump is cancerous, you'll work with your doctor to create a treatment plan. The stage and type of breast cancer will influence your treatment options. If you're unsure how to proceed, ask your doctor to help you make the best treatment decisions.
Last Updated: 2012-06-22
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